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Azimzadeh S, Tabrizi JS, Nosratnejad S, Farahbakhsh M, Azami Aghdash S, Mashhadi Abdolahi H. Effective Factors of Utilization of Inpatient, Outpatient, Diagnostic, and Pharmaceutical Health Services: A Systematic Review. Galen Med J 2019; 8:e1236. [PMID: 34466476 PMCID: PMC8344076 DOI: 10.22086/gmj.v8i0.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/16/2018] [Accepted: 07/22/2018] [Indexed: 12/01/2022] Open
Abstract
Utilization is one of the dimensions of equity in health systems. Identifying the factors affecting utilization of health services can be helpful for interventional purposes. This study systematically reviewed the factors affecting the utilization of inpatient, outpatient, diagnostic, and pharmaceutical services. This systematic review was conducted between 2016 and 2017. The search was performed using keywords based on MeSH in valid databases such as Scopus, Embase, ProQuest, ScienceDirect, PubMed, and Web of Science in the fields of title, abstract, and keyword. Related papers published from 2000 to 2017 were searched. First, the retrieved studies were screened and checked for quality; then, the useful data were extracted and analyzed. Out of the 1178 retrieved publications, 20 studies were included in the final analysis. The identified factors were categorized into 5 areas, including demographic (4 items), socioeconomic (13 items), health services-related (13 items), health status-related (7 items), and health insurance-related factors (2 items), and reported. The findings of this study can be a useful source and a comprehensive body of evidence on the utilization of health services. The results can be used by the policy makers and managers in designing interventions for changing the utilization patterns of health services.
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Affiliation(s)
- Solmaz Azimzadeh
- Iranian Center of Excellence in Health Management and Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Nosratnejad
- Department of Health Services Management, Faculty of Management and Medical Informatic, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Mashhadi Abdolahi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Chen B, Fan VY, Chou YJ, Kuo CC. Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study. BMC Nephrol 2017; 18:36. [PMID: 28122500 PMCID: PMC5267416 DOI: 10.1186/s12882-017-0456-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/19/2017] [Indexed: 11/25/2022] Open
Abstract
Background Despite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD. Methods We conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients. Results During the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care. Conclusions Overall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.
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Affiliation(s)
- Bradley Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Victoria Y Fan
- Department of Public Health Sciences & Epidemiology, University of Hawaii at Manoa, 1960 East-West Road, Biomed D204, Honolulu, HI, USA.,François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, 651 Huntington Ave, Boston, MA, USA.,Center for Global Development, Washington, D.C., USA
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan. .,Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, 13F.-2, No.101, Kaixuan Rd., East Dist, Tainan City, Taiwan.
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Sato K, Miyashita M, Morita T, Tsuneto S, Shima Y. End-of-Life Medical Treatments in the Last Two Weeks of Life in Palliative Care Units in Japan, 2005–2006: A Nationwide Retrospective Cohort Survey. J Palliat Med 2016; 19:1188-1196. [DOI: 10.1089/jpm.2016.0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Adult Nursing/Palliative Care Nursing, School of Health, Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Adult Nursing/Palliative Care Nursing, School of Health, Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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Aldridge MD, Epstein AJ, Brody AA, Lee EJ, Cherlin E, Bradley EH. The Impact of Reported Hospice Preferred Practices on Hospital Utilization at the End of Life. Med Care 2016; 54:657-63. [PMID: 27299952 PMCID: PMC5266506 DOI: 10.1097/mlr.0000000000000534] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Affordable Care Act requires hospices to report quality measures across a range of processes and practices. Yet uncertainties exist regarding the impact of hospice preferred practices on patient outcomes. OBJECTIVE Assess the impact of 6 hospice preferred practices and hospice organizational characteristics on hospital utilization and death using the first national data on hospice preferred practices. DESIGN Longitudinal cohort study (2008-2011) of Medicare beneficiaries (N=149,814) newly enrolled in a national random sample of hospices (N=577) from the National Hospice Survey (84% response rate) and followed until death. OUTCOME MEASURES The proportion of patients at each hospice admitted to the hospital, emergency department (ED), and intensive care unit (ICU), and who died in the hospital after hospice enrollment. RESULTS Hospices that reported assessing patient preferences for site of death at admission had lower odds of being in the highest quartile for hospital death (AOR=0.36; 95% CI, 0.14-0.93) and ED visits (AOR=0.27; 95% CI, 0.10-0.76). Hospices that reported more frequently monitoring symptoms had lower odds of being in the highest quartile for ICU stays (AOR=0.48; 95% CI, 0.24-0.94). In adjusted analyses, a higher proportion of patients at for-profit compared with nonprofit hospices experienced a hospital admission (15.3% vs. 10.9%, P<0.001), ED visit (21.8% vs. 15.6%, P<0.001), and ICU stay (5.1% vs. 3.0%, P<0.001). CONCLUSIONS Hospitalization of patients following hospice enrollment varies substantially across hospices. Two of the 6 preferred practices examined were associated with hospitalization rates and for-profit hospices had persistently high hospitalization rates regardless of preferred practice implementation.
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Affiliation(s)
- Melissa D Aldridge
- *Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York †Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY ‡Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA §New York University College of Nursing, New York, NY ∥Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT
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Luta X, Maessen M, Egger M, Stuck AE, Goodman D, Clough-Gorr KM. Measuring intensity of end of life care: a systematic review. PLoS One 2015; 10:e0123764. [PMID: 25875471 PMCID: PMC4396980 DOI: 10.1371/journal.pone.0123764] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/20/2015] [Indexed: 11/18/2022] Open
Abstract
Background Many studies have measured the intensity of end of life care. However, no summary of the measures used in the field is currently available. Objectives To summarise features, characteristics of use and reported validity of measures used for evaluating intensity of end of life care. Methods This was a systematic review according to PRISMA guidelines. We performed a comprehensive literature search in Ovid Medline, Embase, The Cochrane Library of Systematic Reviews and reference lists published between 1990-2014. Two reviewers independently screened titles, abstracts, full texts and extracted data. Studies were eligible if they used a measure of end of life care intensity, defined as all quantifiable measures describing the type and intensity of medical care administered during the last year of life. Results A total of 58 of 1590 potentially eligible studies met our inclusion criteria and were included. The most commonly reported measures were hospitalizations (n = 44), intensive care unit admissions (n = 39) and chemotherapy use (n = 27). Studies measured intensity of care in different timeframes ranging from 48 hours to 12 months. The majority of studies were conducted in cancer patients (n = 31). Only 4 studies included information on validation of the measures used. None evaluated construct validity, while 3 studies considered criterion and 1 study reported both content and criterion validity. Conclusions This review provides a synthesis to aid in choosing intensity of end of life care measures based on their previous use but simultaneously highlights the crucial need for more validation studies and consensus in the field.
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Affiliation(s)
- Xhyljeta Luta
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andreas E. Stuck
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- University Department of Geriatrics, Inselspital Bern, Bern, Switzerland
| | - David Goodman
- The Dartmouth Institute of Health Policy & Clinical Practice, Lebanon, NH, United States of America
| | - Kerri M. Clough-Gorr
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Section of Geriatrics, Boston University Medical Center, Boston, MA, United States of America
- * E-mail:
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Kirkendall A, Shen JJ, Greenway J, Bai W. Socioeconomic Factors Associated With Posthospitalization Hospice Care Settings: A 5-Year Perspective. Am J Hosp Palliat Care 2014; 33:233-9. [PMID: 25366183 DOI: 10.1177/1049909114556877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Investigating whether socioeconomic characteristics determine if hospice is received at home or in a medical facility is important to examine, considering most patients prefer to die at home. This study relied upon The State Inpatient Data of Nevada. A total of 19 206 discharges were analyzed from the data set between 2009 and 2013. The results indicate that increasingly patients are being discharged to home and overall socioeconomic characteristics appear to have less of an influence over whether hospice is received at home or in a medical facility. Further research on the perspectives of patients would provide insight into whether patients' preferences or socioeconomic characteristics are more influential on where hospice services are received.
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Affiliation(s)
- Abbie Kirkendall
- School of Social Work, Greenspun College of Urban Affairs, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Jay J Shen
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Joseph Greenway
- Center for Health Information Analysis, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Wenbo Bai
- Wellesley College, Wellesley, MA, USA
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